Living with Angina

[sillysally]

I posted 10/9 about new angina that required an angiogram. The Dr did angioplasty and placed a stent in my LAD, 80% blocked.  LAD had previous stent placed 5/01 which is not occluded–which is good news. New stent went further down on the LAD. Bad news-more CAD now than 5/01–RCA is 70% blocked, CCA 60%, and there is generally more CAD now throughout the heart.

Dr thought stent would resolve the angina. However, I still have angina about once a day. They did ECG each time while in hospital and nothing abnormal. The Dr threw his hands up and said he could go in again and stent the 70% blockage.  But the Dr that did the cath with him recommended not even stenting the 80% one. Not sure why–I will ask that Dr when I have my office visit. For now my instructions are not to worry unless 3 nitros don't resolve pain.

Am on Isosorbide for angina and carry sublingual nitro. Angina comes once a day or so. Sometimes early morning before I am awake, sometimes later after I get the kids off to school. Never in pm, never with exercise. Brief, intense (I rate the pain as 7-8 now, it was 4-5 before), pain peaks and then subsides,moves to left arm. Nitro relieves it quickly.

??s: (1)I am resigned to living with this but not sure what I can and can’t do during an angina attack. Do I need to stop all activity and rest while taking the nitro? What if I am driving my car (I am Mom’s taxi service!)? Don't want well meaning friends calling 911 when it is not needed!!

(2) Does having angina once a day put me at greater risk of heart attack or decrease my life expectancy?

Thank you.

[CCF-M.D.-RCJ]

Sillysally,

Thanks for the post.

(1) During an episode of angina, you should take all reasonable steps to relax.  That might include sitting if you were walking, pulling over if you are driving, etc.

(2) The presence of angina does not increase your risk of heart attack as compared to someone just like you (including the blockages) who did not have angina.  I know it's odd, but plenty of people have your same blockages, but do not experience angina.  In fact, there is some evidence that ischemia (which can be inferred to be present due to the presence of the angina) may lead to increased collateral networks, which actually might increase your likelihood of surviving if you did have a heart attack.

Good luck.

[3rdMajor]

I remember your post.  Seems the cath was necessary.  Im curious to see the doc's reply. My understanding of angina; is that it correlates with exertion.  Then again, if it resolves with Nitro, then it is assumed to be angina.  You seem to have contradicting symptoms.
About the blockages - A 70% blockage does not equate to a 70% reduction in blood flow.  One usually doesnt get symptoms of angina until the blockages are greater than 70%.  I didnt become symptomatic until my blockages in LAD was > 90%, and I was sprinting around a basketball court.
Given the progression of your CAD, are you on statin therapy?, and has it helped your lipid profile?

[HealThySelf]

It sounds like you have a diffuse narrowing of your coronary arteries, probably caused by lipid pools throughout the walls of your coronary arteries.

Agressive lipid therapy, diet, and weight control is in order.  I would recommend getting total cholesterol well below 150 and keeping it there.  This may require multiple drugs such as a Lipitor or Crestor + Niaspan + Welchol or Zetia.

The next best thing that you can do for yourself is get in a daily exercise habit.  The 10,000 steps per day program is good.  That's a couple of hours of walking.  I walk 1/2 hour before work and 40 blocks during my lunch hour every day.  Unfortunately I currently don't have a peaceful place to walk at noon.  If you can find a park or woods to walk in it's much more healthful.  I try to get at least 10% of it uphill.  Walking ten minutes uphill per day is as good as an hour on the flat.

A 70% blocked RCA isn't bad -  Mine has been 100% occluded for many years.  I don't really see any need to unblock it anymore - it has built a decent collateral system over the years.

The 60% CCA isn't really much of a factor either unless it progresses.  If it's ostial (at the entrance) watch out, it may be part of a much more dangerous plaque extending into your left main.

As far as the angina goes, it sounds like yours might be more stress related perhaps coupled with a meal. I don't eat before doing anything strenous, as it really limits the cardiovascular blood flow.

You can't really depend on nitro long term as the body gains a tolerance for it.  It also destroys the ability of your endothelial system to produce natural NO for artery dialation.  I wouldn't take it except in an emergency.

The goal is to get the lipid pools out of your arteries, get your remaining endothelial system working at 100%, and stop the progression of your disease.

With me angina is like an old friend.  I push right up against it every day.  It's reasuring to know it's right where I think that it's going to be.  It's normally only present when I exercise after eating or at the beginning of doing something strenous.  That's why it's important to warm up slowly.  It's kind of like having a car with a partially plugged fuel filter.  You can drive it normally if you accelerate slowly and don't try to go 100 miles per hour.  I can do fantastic things, but only so fast.  I can climb several thousand feet per day, but I can't play tennis or run.

It's too bad that they dropped that hardware in you.  You may need the option of servicing the lower portion of that LAD with a single mammary artery bypass at some point.  You might get someone to do that minimally invasive / off pump.

Good Luck To You.